Combination intramedullary fixation and external bone compression apparatus

ABSTRACT

A combination intramedullary fixation and external bone compression apparatus for applying fixation and compression to a bone which has been fractured transversely to form two longitudinal fragments. Such fixation device includes an elongated intramedullary rod for extending substantially the full length of the intramedullary canal of the fractured bone. The intramedullary rod includes a plurality of longitudinally spaced through transverse screw-receiving slots. A compression device is provided which includes a plate for being disposed exteriorally of the bone and spanning the fracture. Such plate includes screwreceiving bores disposed on opposite sides of the fracture whereby an incision may be made in the injured limb adjacent the fracture and the rod inserted through such incision and into the intramedullary canal off one of the bone fragments. The rod may then be driven into the intramedullary canal to drive the leading end of the rod out of one end of the bone fragment sufficiently far to cause the trailing end of such rod to be totally received within such one fragment. Thereafter, the bone fragments may be set and the projecting end of the rod driven back into the intramedullary canal to drive the opposite end of the rod into the second bone fragment to thereby cause such rod to span the fracture and provide support against transverse shifting of the two bone fragments. Thereafter, the compression plate may be placed on the exterior of the bone spanning the fracture and the fracture put in compression. Holes may then be drilled in the bone wall on opposite sides of the fracture and in alignment with the screw-receiving bores in the compression plate and certain of the slots in the rod and screws inserted to maintain the fracture in compression.

limited States Patent [191 Halloran [111 3,709,218 1 Jan. 9,1973

[54] COMBINATION INTRAMEDULLARY FIXATION AND EXTERNAL BONE COMPRESSIDN APPARATUS [75] Inventor: William X. Halloran, Costa Mesa,

Calif. 92626 22 Filed: April 24, 1970 21 Appl. No.: 31,697

Related US. Application Data [63] Continuation-in-part of Ser. No. 737,637, June 17,

[52] US. Cl. ..l28/92 A, 128/92 BC [51] int. Cl. ..A6lf 5/04 [58] Field of Search.....128/92 R, 92 A, 92 B, 92 BA,

128/92 BB, 92 BC, 92 D, 92 F, 92 C, 92 CA, 92 E, 92 EA,92 EB, 92 EC, 92 ED [56] References Cited UNITED STATES PATENTS 2,825,329 3/1958 Caesar ..l28/92 R 2,614,559 10/1952 Livingston ..l28/92 BC 3,076,453 2/1963 Tronzo ..l28/92 BA OTHER PUBLlCATlONS Primary Examiner-Channing L. Pace A ttorney-Fulwider, Patton, Rieber, Lee'and Utecht [57 ABSTRACT A combination intramedullary fixation and external bone compression apparatus for applying fixation and compression to a bone which has been fractured transversely to form two longitudinal fragments. Such fixation device includes an elongated intramedullary rod for extending substantially the full length of the intramedullary canal of the fractured bone. The intramedullary rod includes a plurality of longitudinally spaced through transverse screw-receiving slots. A compressioh device is provided which includes a plate for being disposed exteriorally of the bone and spanning the fracture. Such plate includes screwreceiving bores disposed on opposite sides of the fracture whereby an incision may be made in the injured limb adjacent the fracture and the rod inserted through such incision and into the intramedullary canal off one of the bone fragments. The rod may then be driven into the intramedullary canal to drive the leading end of the rod out of one end of the bone fragment sufficiently far to cause the trailing end of such rod to be totally received within such one fragment. Thereafter, the bone fragments may be set and the projecting end of the rod driven back into the intramedullary canal to drive the opposite end of the rod into the second bone fragmenttotherehy cause such rod to span the fracture and provide support against transverse shifting of the two bone fragments. Thereafter, the compression plate may be placed on the exterior of the bone spanning the fracture and the fracture put in compression. Holes may then be drilled in the bone wall on opposite sides of the fracture and in alignment with the screw-receiving bores in the compression plate and certain of the slots in the rod and screws inserted to maintain the fracture in compression.

13 Claims, 13 Drawing Figures PATENTEDJAI 9 I975 3.709.218

sum 1 0F 2 FIG.I

FIG.2 H63 INVENTOR WILLIAM X. HALLQQ N BY "Wm/M Arronnens COMBINATION INTRAMEDULLARY FIXATION AND EXTERNAL BONE COMPRESSION APPARATUS CROSS REFERENCE TO RELATED APPLICATIONS This application is a continuation-in-part of 'my copending application, Ser. No. 737,637, filed June I7, 1968.

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to intramedullary fixa-' tion devices and external compression devices for reduction of bone fractures.

2. Description of the Prior Art Intramedullary fixation bars have been proposed which include transverse bores therein for receipt of transverse screws. Bars of this type are disclosedin US Pat. Nos. 2,614,559, 2,82l,979, 2,675,801, 2,998,007 and 2,825,329. These prior art fixation devices suffer the shortcoming that they can only be utilized to provide internal fixation and do not provide both internal fixation and external compression.

SUMMARY OF THE INVENTION The internal fixation and external bonecompression apparatus of present invention -is characterized by an elongated intramedullary rod for extending substantially the entire length of the intramedullary canal and formed with longitudinally spaced, through screwreceiving slots. A compression plate is provided for the exterior of the bone to span the fracture and is formed with screw-receiving bores disposed on opposite sides of such fracture whereby the rod may be driven into the intramedullary canal of one of the bone fragments from the fracture site to cause the leading end of such rod to project through the end of such bone fragment. The fracture may then be set and the rod driven back past the fracture site and into the second fragment of the bone to provide intramedullary fixation. Thereafter, the two bone fragments may be pulled together to compress the fracture itself and the plate placed in spanning relationship over the fracture with the screw-receiving bores aligned with certain of the slots in the rod. Holes may then be drilled through the bone wall in alignment with the screw-receiving bores and such slot and screws inserted to cause the compression plate to hold the fracture in compression.

An object of the present invention is to provide a combination intramedullary fixation and external bone compression apparatus of the type described which eliminates the necessity of an orthopedic surgeon electing between intramedullary fixation and external compression of a fracture at the time of reduction.

Another object of the present invention is to provide an intramedullary fixation and external bone compression apparatus of the type described that will enable a surgeon to perform a reduction by inserting an intramedullary fixation rod and to subsequently, if it appears necessary, perform a second operation to place the fracture in compression without removing the intramedullary rod.

A further object of the present invention is to provide a combination intramedullary fixation and internal compression apparatus of the type described wherein the intramedullary rod projects substantially the full length of the intramedullary canal and projects through one end of the bone to be accessible for convenient removal after healing of the fracture is completed.

These and other objects and the advantages of the present invention will become apparent from a consideration of the following detailed description when taken in conjunction with the accompanying drawings.

DESCRIPTION OF THE DRAWINGS FIG. 1 is a plan view of an intramedullary rod utilized in a combination intramedullary fixation and external bone compression apparatus embodying the present invention;

FIG. 2 is a plan view of a second intramedullary rod utilized in a second embodiment of the combination intramedullary fixation and external bone compression apparatus of present invention; I

FIG. 3 is a sideview of the intramedullary rod shown in F IG.'2;

FIG. 4 is a plan view of a third intramedullary rod utilized in a third embodiment of the combination intramedullary fixation and external bone compression apparatus of present invention;

FIG. 5 is a side view of the intramedullary rod shown in FIG.'4;

FIG. 6 is a plan view of a fractured femur which may be reduced by the intramedullary fixation and external .bone compression apparatus of present invention;

FIG. 7. is a plan view of a fractured femur having the first mentioned embodiment of the intramedullary fixation and external bone compression apparatus of present invention applied thereto;

FIG. 8 is a plan view of a tibia having said second embodiment of said combination intramedullary fixation and external bone compression apparatus of present invention applied thereto; 7

FIG. 9 is a plan view of a radius having said third embodiment of said intramedullary fixation and external bone compression apparatus of present invention applied thereto;

FIG. 10 is a partial side view, in enlarged scale, of the intramedullary rod shown in FIG. 1;

FIG. 11 is a horizontal sectional view, in enlarged scale, taken along the line 11-1 1 of FIG. 7;

FIG. 12 is a vertical sectional view taken along the line 12-12 of FIG. 11; and

FIG. 13 is a vertical sectional view, in enlarged scale, taken along the line 1313 of FIG. 8.

A DESCRIPTION OF THE PREFERRED EMBODIMENT The combination intramedullary fixation and external bone compression apparatus, generally designated 20 (FIGS. 1 and 7) includes a generally cylindrical elongated intramedullary rod 21 for installation in the intramedullary canal 23 of a femur 22 (FIG. 11). The intramedullary rod 21 is formed with a plurality of Iongitudinally spaced elongated through slots 25 (FIGS. 1 and 12) for receipt of transverse screws 27 which secure an external bone compression plate device, generally designated 28 (FIG. 7) to the exterior of the femur 22. Thus, referring to FIGS. 6 and 7, supposing that the femur22 experiences a single transverse fracture 29, it being assumed that the lower butterfly fracture 30 does not exist, an incision may be made in the thigh adjacent such fracture and the intramedullary rod 21 inserted through such incision and into the intramedullary canal of the upper fragment of the femur 22. The intramedullary rod 21 may be driven through the intramedullary canal and out the upper end of the femur in a retrograde manner, it being realized that the wall of the upper end of the femur is sufficiently soft to enable the relatively pointed rod to be driven therethrough. An incision may then be made for egress of the rod from the buttock and such rod may be driven sufficiently far into the upper portion of the femur to fragments drawn. together by a bone compression device, and holes drilled through the wall of such femur form a raised area in the buttock and a small incision may be made for projection through the buttock of such rod. The rod 21 may then be continued to be driven through the upper portion of the femur 41 until the lower extremity thereof is entirely submerged within the lower end of such femur fragment. Thereafter, the femur fragments 41 and 43 may be pulled axially apart against the force of the patients contracting leg muscles to spread the adjacent ends of the femur fragments apart to clear one another while they are set in axial alignment. Thereafter, the intramedullary rod 21 may be driven downwardly within the intramedullary canal of the lower femur fragment 43 until the upper extremity of such rod projects only a half inch or so above the upper end of the femur as shown in FIG. 7. v

Thereafter, the compression device 28 may be applied to the stripped femur in the area of the fracture 29. The femur 22 may be X-rayed to determine the orientation of the slots 25 and the positioning thereof. A bore 48 (FIG. 11) may then be drilled through the wall of the femur 22 in alignment with one of the intramedullary rod slots '25. The compression plate 38 may then be positioned on the femur 22 and a screw 27.

' installedto secure such compression plate to the upper in alignment with the slots 25 of the intramedullary rod for receipt of the transverse screws 27 to hold the fracture 29 in compression. Consequently,.the fracture 29 will be subjected to intramedullary fixation and also to external bone compression to enable early ambulation of the patient and accelerating healing of such fracture.

' The intramedullary rod 21 is formed on its opposite extremities with tapered portions which are formed on their peripheries with self-breaching grooves 31 whereby such rods may be driven into the intramedullary canal without first reaming out such canal. Longitudinal flutes 37 extend along opposite sides of the tapered portions and lead to. through transverse passages whereby broached bone material can feed back along such flutes 37 and into the transverse storage passages 35. I

Referring to FIGS. 7 and 11, the compression device 28 includes a semi-circular compression plate 38 formed to compliment the external contour of the femur 22. The plate includes a plurality of longitudinally aligned screw-receiving bores 39 for receipt of 4 the screws 27.. It is noted that the screws 27 are of sufficient' length of extend entirely through the femur 22 and are threaded on their extremities for receipt of conventional nuts 49.

To best understand operation of the combination intra'medullaryfixation and bone compression apparatus 20 of present-invention, it will be assumed that a femur 22 has received a fracture 29 along its intermediate femur fragment 41. A conventional bone compression device may then be engaged with the lower extremity of the compression plate 38 and with the lower fraglength to form upper and lower femur fragments 41 and c 43, respectively. Frequently, the bone fragments 41 and 43 will be axially off-set whereby an incision may be made in the thigh adjacent the fracture 29 and access may be had to the intramedullary canal .23 of the upper femur fragment 4.1. The upper end of the intramedullary rod 21 is then fed into the intramedullary canal of the upper femur fragment 41 and is driven through such canal and out the upper end of the femur 22 or trocanter 45 to form a through passage 46. The projecting upper end of the intramedullary rod 21 will ment 43 and actuated to compress the fracture 29. While such bone compression apparatus holds the fracture 29 in compression, a drill may be extended through the bores 39 vof the compression plate for the lower two screws 27 (FIG. 7) to utilize such compression plate as a jig for drilling of bores 48 through the wall of the lower femur fragment 43; The lower two screws 27 may then be inserted and the nuts 49 screwed thereon; Then, a bore may be drilled for the final transverse screw 27 in the upper femur fragment 41 and such screw inserted and the nut 49 screwed thereon.

It will be noted that the longitudinal slots 25 in the intramedullary rod 21 must be of sufficient length to enable the transverse screws 27 to shift longitudinally therein during compression of the fracture 29 during installation of the compression device 28. Also, the elongated characteristics of the slot 25 allows greater flexibility in the longitudinal location of the bores 48 for the screws 27 thereby eliminating the preciseness which would otherwise be required for the location and 'angularity of the bores 48 to assure alignment of the various passages in the plate 38, femur 22 and rod 21. It has been found that the slots 25 should occupy more than 50 percent of the total length of the intramedullary rod 21 and preferably more than percent of the total length of such rod to insure that the bores 48 drilled in the femur 22 will register therewith and that there will be capability for sufficient longitudinal shifting of the screws 27 to allow compression of the frac-' ture 29. The rod 21 has been formed with coarse spiral peripheral threads extending its full length whereby such rod may be screwed into intramedullary canal 23 and will itself serve to draw the bone fragments together to apply compression to the fracture-29.

The intramedullary rod 21 is eighteen inches long to project substantially the full length of an adult femur 22 and is one half inch in diameter to form a strong rod which will occupy substantially the full cross-section of such intramedullary canal to provide secure intramedullary fixation for the fracture 29. Obviously, the length and diameter will vary for different lengths and diameter intramedullarycanals of different size femurs. Further, since there is no requirement for sawing additional openings in the bone wall, other than that at the top of the femur for projection of such rod,

the likelihood of infection in the bone is held down. Further, with the rod projecting from the top of the femur as shown in FIG. 7, if the femur 22 should become infected or other complications arise, access may be had to the upper end of such rod for removal thereof without the necessity of breaking down the fracture site 29 thereby destroying the entire reduction. Also, the compression device serves to hold the fracture 29 in compression to accelerate the healing rate thereof.

A particularly important advantage of the combination intramedullary fixation and external bone compression device of present invention is the capability of the intramedullary rod 21 to be utilized independently of the compression device 28 to apply fixation to the fracture 29. The rod 21 is of substantially the same cross section as the medial portion of the intramedullary canal 23 and extends to substantially the full length of such canal to prevent such rod from longitudinal shifting therein and migrating away from the fracture site 29. Further, the injured leg may be X-rayed to determine the orientationand location of the transverse slots 25 at opposite ends of the rod, incisions made, and holes drilled through the walls of the femur for insertion of transverse anchor screws 63 which will limit longitudinal migration of the rod 21.

If, at a later date, it becomes apparent that it would be advisable to apply external compression to the fracture site 29, the surgeon may make an incision and strip the bone adjacent the fracture site 29 for installation of the compression device 28 and such compression device may be installed substantially the same as described hereinabove without necessity of removing the intramedullary rod 21 thereby reducing the operational shock on the patient to enable many farctures 29 of this type, to be put in compression which could not otherwise be compressed because of the requirement for removing conventional intramedullary rods before application ofa compression device.

Turning now to the butterfly fracture 30 shown in FIGS. 6 and 7, the intramedullary rod 21 of present invention enables such fractures to be relatively conveniently and effectively reduced by application of a hold-down plate 55. A butterfly fracture 30 is characterized by a section of bone actually being separated from the main bone fragment 43 and 56. Frequently, the bone fragments 43 and 56 will be off-set from axial alignment with one another and the intramedullary rod 21 may be installed in a retrograde manner as described hereinabove and, thereafter, the butterfly fragments 30 will be placed in position and the holddown plate 55 secured thereover. Such hold-down plate 55 is formed with bores for receipt of transverse screws 54 and a drill may be projected through such bores to drill a hole through the walls of the femur in alignment with respective slots 25 for receipt of such transverse screws. The screws 54 may then be installed and nuts screwed thereon and tightened to hold such hold-down plate 55 firmly on the butterfly fragment 30 to prevent any tendency of the femur 22 to telescope together as weight is applied thereto to thereby prevent shortening of the patients leg.

Referring now to the combination tibia intramedullary fixation and external bone compression apparatus, generally designated 65, shown in FIGS. 3 and 8, such apparatus is intended for application to a tibia 75 having a transverse fracture 81 intermediate its length. The apparatus 65 includes an elongated tibia intramedullary rod formed with a plurality of longitudinally spaced slots 67 (FIG. 2) and is further formed on its opposite ends with bent portions 71 and 73 for complimenting the curved off portions at the opposite ends of a normal tibia 75. Further, the proximal extremity of the tibia intramedullary rod is formed with screw threads 76 for connection with a conventional inserter and extractor mechanism. It is noted that the intramedullary rods of present invention may be relatively flexible to facilitate installation through a hole drilled in the side wall of the fractured bone near one extremity thereof.

The fixation and compression plate apparatus also includes a compression plate 77 (FIG. 8) similar to the compression device 28 having a bore formed at opposite ends thereof for receipt of transverse screws 79 located on opposite sides of a fracture 81. Also, a pair of transverse anchor screws 83 and 85 are provided for installation at the outer extremities of the intramedullary rod to secure such rod against longitudinal shifting within the radius when such rod is utilized without the compression plate 77.

In operation, the tibia fixation and compression apparatus may be utilized by making an incision near the patient's knee area, drilling a bore 86 through the wall of the fractured tibia near the upper extremity thereof, and inserting the intramedullary rod through such bore and down the intramedullary canal and past the fracture 81 to provide support thereof. The upper extremity 76 of the rod will be left projecting a short distance through the wall of the tibia as shown in FIG. 8 so an inserter and extractor device can conveniently be connected with'the end 76 thereof if it becomes necessary to remove'such rod at a later date. Also, incisions may be made near the fracture site 81, the tibia stripped and the compression plate 77 applied to the compressed fracture site 81 in a manner similar to that described hereinabove for the compression plate 38. Thus, intramedullary fixation will be applied to the fracture 81 and such fracture will be compressed to accelerate the healing rate thereof.

The radius intramedullary fixation and compression apparatus, generally designated 89, shown in FIGS. 4, 5 and 9 includes a radius intramedullary rod formed with a plurality of longitudinally spaced elongated through transverse slots 91 and including an arcuate intermediate portion for complementally fitting the medial portion of a normal radius 97 (FIG. 9) and a relatively straight end portion for complementally fitting the proximal portion of such radius.

Still referring to FIG. 9, the radius fixation and compression apparatus 89 also includes a pair of compression devices and 107 which may be utilized in compressing respective fracture sites 101 and 103 in a manner similar to that described hereinabove with respect to the compression device 28. Also, a pair of transverse anchor screws 1 l l and l 13 are provided for extension through the transverse slots 91 when the intramedullary radius rod is utilized without the compression devices 105 and 107.

In operation, the radius fixation and compression device 89 is utilized in a manner similar to that described hereinabove with respect to the tibia fixation and compression device 65. That is, an incision may be made in the skin adjacent the distal extremity of the radius 97, a bore 108 drilled in the wall of such radius and the intramedullary rod inserted through such bore and up the intramedullary canal past the fracture sites 101 and 103 until such rod projects only approximately one quarter of an inch out the distal end of the radius.

The incision may then be closed and if it becomes necessary at alater date to remove the rod, ready access may be had to the projecting extremity thereof. Also, incisions may be made adjacent the fracture sites 101 and 103, the radius stripped, and the compression devices 105 and 107applied to the radius 97 in a manner similar to that for the compression device 28.

From the foregoing it will be apparent that the intramedullary fixation and external bone compression apparatus of present invention provides a convenient means for enabling a surgeon to perform reduction of a fracture which will effect both intramedullary fixation and compression to the fracture site. Further, the surgeon may elect to utilize intramedullary fixation at the time of initial reduction and may, thereafter, apply external compression to the fracture site without removing the intramedullary rod. The intramedullary rod can be conveniently installed from the fracture site in a retrograde manner and may be left projecting from the end of the fractured bone .for convenient removal at a later date in case of infection or breakage without the necessity of tearing down the fracture site. Further, the apparatus of present invention provides a convenient means for reducing a butterfly fracture utilizing intramedullary fixation and holding means for securing the butterfly fragment in place to prevent telescoping of the fractured bone which would result in the shortening of the patient's limb.

Various modifications and changes may be mad with regard to the foregoing detailed description without departing from the spirit of the invention.

lclaim:

1. Combination intramedullary fixation and external bone compression apparatus for use with a bone that has been fractured medially into longitudinal fragments, said apparatus comprising:

an elongated intramedullary rod of substantially regular longitudinal cross section for extension longitudinally through the intramedullary canal of said bone to span the fracture site and including a plurality of longitudinally spaced, through, transverse screw-receiving slots elongated in the longitudinal direction of said rod;

a compression device including plate means for being disposed exteriorlyof said bone in spanning relationship over said fracture, compression anchor means includingpins'adapted to be connected on their respective one ends with said plate means in longitudinal spacedapart relationship for being inserted slidingly through respective ones of said slots and being formed on their ends opposite said one ends with fastener means, said anchor means further including individual fasteners for fastening to said respective fastener means; said slots having a cross section in the longitudinal direction of said rod at least twice the corresponding cross section of said pins for accommodating longitudinal shifting of said pins with respect to said rod whereby after saidrod is inserted in said intramedullary canal to span said fracture site to support the bone segments on opposite side of said site from shifting transversely with respect to one another, a hole may be drilled in said bone on one side of said fragment in alignment with one of said slots, one of said pins inserted therein, said bone segments drawn together to compress said fracture site, said one slot accommodating longitudinal shifting of said one pin and a second hole drilled in said bone on the opposite side of said site and the other of said pins inserted to hold said fracture in longitudinal compression. 2. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said intramedullary rod is at least 10 inches long to project a substantial distance through the medial portion of said bone. 3. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said intramedullary rod is at least 15 inches long to extend substantially the full length of said bone. 4. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said intramedullary rod is formed on its opposite extremities with self broaching grooves to thereby eliminate the necessity of reaming said intramedullary canal before said rod is inserted. 5. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said slots occupy at least 50 percent of the medial portion of said intramedullary rod. 6. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said intramedullary rod is circular in cross section to complimentally fit the cross section of said intramedullary canal and to resist bending in all planes. 7. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said intramedullary rod is at least 15 inches long to project throughout the medial portion of said intramedullary canal and to remain projecting from one end of said bone for convenient access after said fracture has healed without cutting through said bone. 8. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said intramedullary rod is at least 10 inches long whereby said rod may be inserted through the incision at said fracture site and into the intramedullary canal of one of said bone fragments in a retrograde manner and drive, out said one extremity of said bone, said fracture set, the projecting end of said rod driven back into said intramedullary canal to drive said rod into the other bone fragment.

9. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said intramedullary rod is substantially one half inch in cross section and 18 inches long.

10. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein:

said slots are at least four times as long in longitudinal cross section as the longitudinal transverse cross section of said pins.

1 1. Intramedullary fixation apparatus for applying intramedullary fixation to a fractured bone while retaining fractured bone segments against telescoping together at the fracture site, said apparatus comprising:

an elongated intramedullary fixation rod for extension longitudinally through the intramedullary canal of said bone and having a sufficient transverse cross section to extend substantially across the cross section of said canal to engage the opposite sides thereof at the fracture site to span the fracture site, said rod being formed with a plurality of longitudinally spaced through screw-receiving slots;

a hold-down plate for being disposed exteriorly of said bone at said fracture site;

a pair of screws connectable with said hold-down plate and extendable through respective ones of said slots and through a fractured bone to cooperate with said hold-down plate and said bone to support said bone segments against telescoping together at said fracture site.

12. lntram'edullary fixation apparatus as set forth in claim 11 wherein:

said intramedullary rod is at least three-eighths of an inch in diameter to substantially fill the medial portion of said intramedullary canal.

l3. Intramedullary fixation apparatus as set forth in claim 11 wherein:

said intramedullary rod is at least 15 inches in length to project substantially throughout the medial portion of said intramedullary canal. 

1. Combination intramedullary fixation and external bone compression apparatus for use with a bone that has been fractured medially into longitudinal fragments, said apparatus comprising: an elongated intramedullary rod of substantially regular longitudinal cross section for extension longitudinally through the intramedullary canal of said bone to span the fracture site and including a plurality of longitudinally spaced, through, transverse screw-receiving slots elongated in the longitudinal direction of said rod; a compression device including plate means for being disposed exteriorly of said bone in spanning relationship over said fracture, compression anchor means including pins adapted to be connected on their respective one ends with said plate means in longitudinal spaced apart relationship for being inserted slidingly through respective ones of said slots and being formed on their ends opposite said one ends with fastener means, said anchor means further including individual fasteners for fastening to said respective fastener means; said slots having a cross section in the longitudinal direction of said rod at least twice the corresponding cross section of said pins for accommodating longitudinal shifting of said pins with respect to said rod whereby after said rod is inserted in said intramedullary canal to span said fracture site to support the bone segments on opposite side of said site from shifting transversely with respect to one another, a hole may be drilled in said bone on one side of said fragment in alignment with one of said slots, one of said pins inserted therein, said bone segments drawn together to compress said fracture site, said one slot accommodating longitudinal shifting of said one pin and a second hole drilled in said bone on the opposite side of said site and the other of said pins inserted to hold said fracture in longitudinal compression.
 2. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said intramedullary rod is at least 10 inches long to project a substantial distance through the medial portion of said bone.
 3. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said intramedullary rod is at least 15 inches long to extend substantially the full length of said bone.
 4. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said intramedullary rod is formed on its opposite extremities with self broaching grooves to thereby eliminate the necessity of reaming said intramedullary canal before said rod is inserted.
 5. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said slots occupy at least 50 percent of the medial portion of said intramedullary rod.
 6. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said intramedullary rod is circular in cross section to complimentally fit the cross section of said intramedullary canal and to resist bending in all planes.
 7. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said intramedullary rod is at least 15 inches long to project Throughout the medial portion of said intramedullary canal and to remain projecting from one end of said bone for convenient access after said fracture has healed without cutting through said bone.
 8. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said intramedullary rod is at least 10 inches long whereby said rod may be inserted through the incision at said fracture site and into the intramedullary canal of one of said bone fragments in a retrograde manner and drive, out said one extremity of said bone, said fracture set, the projecting end of said rod driven back into said intramedullary canal to drive said rod into the other bone fragment.
 9. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said intramedullary rod is substantially one half inch in cross section and 18 inches long.
 10. Combination intramedullary fixation and bone compression apparatus as set forth in claim 1 wherein: said slots are at least four times as long in longitudinal cross section as the longitudinal transverse cross section of said pins.
 11. Intramedullary fixation apparatus for applying intramedullary fixation to a fractured bone while retaining fractured bone segments against telescoping together at the fracture site, said apparatus comprising: an elongated intramedullary fixation rod for extension longitudinally through the intramedullary canal of said bone and having a sufficient transverse cross section to extend substantially across the cross section of said canal to engage the opposite sides thereof at the fracture site to span the fracture site, said rod being formed with a plurality of longitudinally spaced through screw-receiving slots; a hold-down plate for being disposed exteriorly of said bone at said fracture site; a pair of screws connectable with said hold-down plate and extendable through respective ones of said slots and through a fractured bone to cooperate with said hold-down plate and said bone to support said bone segments against telescoping together at said fracture site.
 12. Intramedullary fixation apparatus as set forth in claim 11 wherein: said intramedullary rod is at least three-eighths of an inch in diameter to substantially fill the medial portion of said intramedullary canal.
 13. Intramedullary fixation apparatus as set forth in claim 11 wherein: said intramedullary rod is at least 15 inches in length to project substantially throughout the medial portion of said intramedullary canal. 